Multiple traction band-assisted endoscopic submucosal dissection of a giant colorectal lipoma after unsuccessful unroofing.

Background and Aims: Large colorectal lipomas can cause symptoms such as abdominal pain, bleeding, and intussusception. Despite increasing reports of endoscopic treatments, endoscopic resection of large lipomas remains technically challenging. Here, we report a case of successful endoscopic submucosal dissection (ESD) using multiple traction bands for a large lipoma after failed unroofing. Methods: A 55-year-old woman with chronic abdominal pain had a 70-mm submucosal tumor in the ascending colon, confirmed to be a lipoma. Initial unroofing failed because of poor electrical conductivity of the lipoma. Two months later, with the patient having persistent symptoms and a remaining 50-mm lipoma, ESD was performed. Multiple traction bands were clipped between the lipoma and the contralateral wall to lift the tumor and improve visualization. Results: ESD was successfully performed using multiple traction devices applied sequentially to maintain tension and visibility during dissection. The lesion was completely removed en bloc, and the defect was closed using the clip-with-line pulley-securing technique. Histology confirmed a benign lipoma. The patient remained symptom free with no recurrence at 1-year follow-up. Conclusions: Multiple traction-assisted ESD is a safe and effective approach for large colorectal lipomas, enabling minimally invasive resection while reducing the risk of perforation and recurrence.